ISSN 2320 - 2602

Volume 7 No.12, December 2018

Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
International Journal of Advances in Computer Science and Technology
Available Online at http://www.warse.org/IJACST/static/pdf/file/ijacst017122018.pdf
https://doi.org/10.30534/ijacst/2018/017122018

Literature Review on Medical Diagnosis Using Hybrid Fuzzy Logic

Yosef Berhanu Buladie 1 , Lars Rune Christensen (PhD) 2
1
Sudan University of Science and Technology, College of Computer Science and Information Technology
Khartoum, Sudan, joshecomp@gmail.com
2
IT-University of Copenhagen, Copenhagen, demark,lrc@itu.dk

ABSTRACT 1. INTRODUCTION

Leishmaniasis, a parasitology disease caused by more than

Leishmaniasis is neglected tropical a protozoan infection
disease caused by Leishmania parasites. It is broadly
classified into two major type such as Visceral Leishmaniasis
(VL) and Cutaneous Leishmaniasis (CL). VL (also known as
Kala-Azar) is the most severe form of Leishmaniasis, almost
always fatal if untreated. In Africa, the worst VL affected
region is East Africa especial Sudan and Ethiopia. The
annual burden of visceral Leishmaniasis (VL) in Ethiopia is
estimated to be between 4,500 and 5,000 cases, and the
population at risk is more than 3.2 million. From the total
estimation, 60% cases are found in areas of Northwest
Ethiopia in Metema and Humera.
In a medical environment, incomplete information and
imprecise are driving to making an incorrect medical
decision and maximize the rate of morbidity and mortality.
Fuzzy logic technology enables to provide a simple way to
attain to a certain conclusion from vague, imprecise and
ambiguous medical data. Hybridize fuzzy logic with soft
computing algorithm recommended to overcome the
weakness of one with the strength of the other. Such expert
system has a successful tool for building intelligent decision
making that would have a human like reasoning capability.
The aim of this article review researches working one hybrid
fuzzy logic for medical diagnosis which influenced on
maximizing the accuracy medical decision. All the related
research work inspires us to design a novel hybrid fuzzy
expert system, provide medical diagnosis on Visceral
Leishmaniasis.
The researcher will conduct intensive observation at
Northwest Ethiopia VL endemic areas such as Metema,
Abdurafie and Humera and also we will use domain experts’
interview, questionnaires and document review as data
collection methods. Finally, the researcher will test a system
through system testing and user acceptance to check whether
a system gives a significant contribution to health care or not.
Key word: Fuzzy logic, Type-I fuzzy logic, Type-II Fuzzy
logic, Visceral Leishmaniasis, Expert system
83
20 species and subspecies of the protozoan Leishmania
parasites [1]. It is transmitted between humans and other
mammalian hosts by female phlebotomine sandflies. Over 90
sandfly species are known to transmit Leishmania parasites
[2].
Leishmaniasis consists of four main clinical syndromes:
cutaneous leishmaniasis, mucocutaneous leishmaniasis (also
known as espundia), visceral leishmaniasis (VL; also known
as Kala-Azar); and post-Kala-Azar Dermal Leishmaniasis
(PKDL). In cutaneous leishmaniasis, the patient generally
presents with one or several ulcer(s) or nodule(s) in the skin.
Different species of Leishmania can infect the macrophages
in the dermis, with variable clinical presentations and
prognoses. Mucocutaneous leishmaniasis leads to a partial or
total destruction of mucous membranes of the nose, mouth
and throat. Over 90% of mucocutaneous leishmaniasis cases
occur in Bolivia (the Plurinational State of), Brazil, Ethiopia
and Peru [3] [4].
VL is a systemic disease that is fatal if left untreated and is
caused by L. donovani. There are two types of VL, which
differ in their transmission characteristics: zoonotic VL is
transmitted from animal to vector to human and
anthroponotic VL is transmitted from human to vector to
human. In the former, humans are occasional hosts and
animals, mainly dogs, are the reservoir of the parasite.
Zoonotic VL is found in areas of L. infantum transmission
whereas anthroponotic VL is found in areas of L. donovani
transmission [3].
PKDL is characterized by a macular, maculo-papular or
nodular rash and is a complication of VL that is frequently
observed after treatment in Sudan and more rarely in other
East African countries and in the Indian subcontinent. It can
also occur in immunosuppressed individuals in L. infantum-
endemic areas. The interval between treated VL and PKDL
is 0–6 months in Sudan and 6 months to 3 years in India.
PKDL cases are highly infectious because the nodular
lesions contain many parasites, and such cases are the
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
putative reservoir for anthroponotic VL between epidemic
cycles [3].
According to (WHO, 2015) report, Leishmaniasis is
prevalent in 89 countries across the world, affecting an
estimated 12 million people with approximately 2 million
new cases per year. More than 350 million people live in
disease risk area. The estimated yearly incidence is 0.6–1
million cases of cutaneous Leishmaniasis (CL). Above 95 %
CL cases occur in the Americas, the Mediterranean basin, the
Middle East and Central Asia. Over two-thirds of new CL
cases occur in 6 countries: Afghanistan, Algeria, Brazil,
Colombia, Iran and the Syrian Arab Republic. An estimation
0.2 – 0.4 million cases of visceral Leishmaniasis. It is
associated with about 2,357,000 disability- adjusted life
years (DALYs), 946,000 in men and 1,410,000 in women,
representing a significant rank among communicable
diseases. [5].
VL is the most severe form of leishmaniasis, almost always
fatal if untreated and is characterized by a range of
symptoms, including fever, weight loss, anemia, weakness,
hepatomegaly, lymphadenopathy and splenomegaly. The
incubation period ranges from three to eight months. Infected
individuals are therefore unlikely to develop symptoms for
several months after infection [3]. An estimated 500,000 to
900,000 new cases of VL occur worldwide each year, and
from this, greater than 90% of VL human cases occur in
seven countries, namely Brazil, India, Ethiopia, South Sudan,
and Sudan, Kenya, Somalia. Eastern Africa has the second
highest number of VL cases, after the Indian Subcontinent
[4].
Available data from eastern Africa show that the
leishmaniasis burden, especially that of Visceral
leishmaniasis (VL), is a major problem to public health in the
region. Every year, health facilities report thousands of cases
and hundreds of deaths, and in epidemic years the toll can be
much higher. VL epidemics during the 1980s and 90s killed
100,000 people in Sudan alone. With routine surveillance in
the region mostly limited to passive case detection at a few
health facilities equipped to diagnose and treat the disease,
the current morbidity and mortality figures likely
underestimate the regional leishmaniasis burden. Prevalence
surveys in a few sites and epidemiological simulations
indicate that there is a large underlying pool of infected and
infectious individuals [6].
Ethiopia is one of the ten high burden countries for
Leishmaniasis. VL is predominantly found in the lowlands
with varying degrees of endemicity. It is estimated that the
annual burden of VL ranges from 4,500 to 5,000 cases and
population at risk is more than 3.2 million. Some of the
factors found to be associated with the spread include
population movements to and from endemic focus areas,
poverty and malnutrition associated with presence of the
sandfly vector and reservoirs [7] [8].
84
In Northwest, the most important VL endemic areas are
found in Metema and Humera lowlands, which accounts for
approximately 60% of cases in the country. These endemic
areas lay in Amhara and Tigray regional states, bordering to
Sudan and Eritrea that are known in agro ecological zones,
with wide open plains covered by bush scrubs and Acacia
woodland. The woodland cover is in process of being
replaced by extensive commercial agriculture that produces
sesame and cotton as the main cash crop.
VL remains endemic in Humera-Metema foci and even in
recent years Medecins Sans Frontieres (MSF) treatment
centre treated 2000 to 5000 VL cases per year at one point in
time. Recent spread beyond the Metema and Humera plains
to villages in Tahtay Adiabo district and Sheraro Kebeles,
Welkaite and Armacheho districts in the Tigray and Amhara
regional states have been reported. Especially in villages of
Sheraro VL claimed the lives of hundreds and remains
circulating since its first investigation. Returning daily
labourers from VL endemic areas of Humera and Metema
are believed to introduce the parasite in Sheraro focus . In
2007 around 2450 primary cases have been reported since
the beginning of the outbreak with the majority of cases
being treated at Addis Zemen health center, run by MSF. The
rapid spread of the disease was attributed through
misdiagnosis of cases with drug-resistant malaria, which is
endemic in the area [9] [10] [11].
In recent years, an expert system has been used to solve
many complex problems by developing intelligent systems
and fuzzy logic has proved to be a powerful tool for
decision-making systems, such as expert systems and pattern
classification systems. Fuzzy set theory has already been
used in some medical expert systems. In traditional rule-
based approach, knowledge is encoded in the form of
antecedent-consequent structure. When new data is
encountered, it is matched to the antecedents clauses of each
rule, and those rules were antecedent match a data exactly
are fired, establishing the consequent clauses. This process
continues until the desired conclusion is reached, of no new
rule can be fired. In the past decade, fuzzy logic has proved
to be wonderful tool for intelligent systems in medicine.
Knowledge based systems at the department of medical
computer sciences pursue methodological research in and
practical development of knowledge based computer systems
to assist in the decision making processes for all areas of
medical application [12] [13].
Using fuzzy logic becomes the current trends of researchers.
According to [11] fuzzy logic is useful for real world
problem where there are different kinds of uncertainty. One
kind of uncertainty is fuzziness that is no sharp transition
from complete membership to non-membership. In human
reasoning much of the logic is not based on two values, it is
not even multi-valued but fuzzy truth. In conventional logic
everything is considered true or false, black or white but
nothing in between. Fuzzy logic on the other hand takes into
consideration all values in between. This types of uncertainty
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
are mostly observed in medical cases during diagnosis,
because the symptoms and related signs of the patients are
subjective, which are not able to be expressed in the
conventional logic. In one symptom, there are different
levels of measurements in between. Because of this fuzzy
logic is appropriate for medical cases. Fuzzy logic is based
on fuzzy sets; a fuzzy set is a class of objects with continuum
grades of membership" [13].
A fuzzy set is an extension of a conventional set. It has
elements belonging to it to some degree of membership. This
degree varies from 0 to 1. In conventional logic, the degree
of membership is either 0 for non-membership or 1 for
complete membership. Fuzziness results from imprecise
boundaries of fuzzy sets. It is based on emulating human
thinking where elements are linguistic variables. Linguistic
variables are variables whose values are sentences not
numbers. Fuzzy sets are actually properties and fuzzy logic
provides a way of finding conclusions for ambiguous inputs.
Fuzzy sets represent common sense linguistic labels like
slow, fast, small, large, heavy, low, medium, high, tall, etc. A
given element can be a member of more than one fuzzy set at
a time [14].
Various types of fuzzy membership functions are used,
including triangular, trapezoidal, generalized bell shaped,
Gaussian curves, polynomial curves, and sigmoid functions.
According to Siler and Buckley, fuzzy knowledge base
systems are categorized into two types. First is fuzzy control
system, which accepts inputs as numbers. The input number
is then translated into a linguistic term. In fuzzy control
systems, the application domain is defined. The second type
is fuzzy reasoning, which is a system that attempts to
emulate human thinking where the domain is not defined.
Such a system deals with numbers and linguistic variables.
So now a day fuzzy logic is an appropriate tool in order to
develop knowledge base systems for conditions with
different uncertainty or values in between, like linguistic
variables [15].
Type-1 and type-2 fuzzy sets were introduced by Zadeh in
1965 and 1975 respectively. Both are handling the
process/manipulate data and information affected by
uncertainty/imprecision. In especially type-2 fuzzy sets were
essentially ‘fuzzy fuzzy’ sets where the fuzzy degree of
membership is a type-1 fuzzy set [16] [17].
Nowadays information communication technology grows
rapidly and is being applied in different areas so as to
increase the productivity, quality of service, efficiency and
effectiveness of the organization. This proposal will show the
importance of information communication technology on
improvements of medical and health sectors of the country
by modelling and developing a mobile-based knowledge
base system to facilitate continuous healthcare service
provision for identifying diseases and making intervention
mechanism.
85
Leishmaniasis represents a complex and heterogeneous
disease that emerged as epidemiologically important
infection in Ethiopia. Over the years the burden is increasing
and spreading out to new sites pausing several unanswered
questions that make control of the disease more difficult
[18]. Visceral Leishmaniasis is a higher priority than CL as it
is a fatal disease if left untreated [1].
According to the FMoH [10], global Leishmaniasis estimate,
Ethiopia is one of the ten high burden countries for VL. VL
is predominantly found in the lowlands with varying degrees
of endemicity. It is estimated that the annual burden of VL
ranges from 4,500 to 5000 cases. Some of the factors found
to be associated with the spread include population
movements to and from endemic focus areas, poverty and
malnutrition associated with the presence of the sandfly
vector and reservoirs [10].
The endemicity of VL was recently extended to at least five
administrative regions, namely, Amhara, Tigray, Southern
Nations Nationalities and Peoples’ Region, Oromia and
Somali. In addition, there have been recent outbreaks in
northern and southern parts of the country: Libo Kemkem
Woreda in Amhara region, T/Adiabo Woreda in Tigray
region and Imey in Somali region. The tendency of the
disease to spread to new areas was also noted, as in the case
of the Silte outbreak [10].
Currently, efforts are undergoing in risk mapping of the
disease throughout the country. The most important VL
endemic areas in Ethiopia are found in the northwest
(Metema- Humera lowland), which accounts for
approximately 60% of cases, and in southwest Ethiopia
(Lake Abaya, Omo river plains and Segen and Woito
valleys). The spread of VL to unusual highland habitats and
new foci was hypothesized to have been due to the
introduction of the parasite, probably on multiple occasions,
by migrant agricultural labourers returning to their villages
from seasonal work from VL endemic areas [19].
The government of Ethiopia, like other Leishmaniasis
endemic countries, has been taken many steps pushing
forward the response to disease and many lives saved as a
result. However, there remains a great need for increased
preventative measures and accessibility to early diagnosis
and effective treatment if the disease is ever to be eliminated
[10].
According to FMoH, 2013 report, in Ethiopia VL
epidemiology remains complex because of the diversity of
risk factors involved, and its control is becoming an
increasing challenge. Information regarding Leishmaniasis is
inadequate in developing countries and surveillance systems
for Leishmaniasis are poorly established. Therefore, data
collection and their analysis for monitoring and evaluation of
the program is a crucial aspect.
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
According to “Visceral Leishmaniasis Diagnosis and
Treatment Guideline for Health Workers in Ethiopia, 2013
the treatment of the disease is poorly established because of
most of the rural health worker treats the Leishmaniasis like
one of resistance tropical diseases like malaria and
tuberculosis. In the result of this many people are died.
On the time of the researcher observation, at Metema and
Abdurafie. There is the scarcity of senior experienced
medical doctors, resident health workers are not capable
enough to provide appropriate medical diagnosis and
treatment for patients.
In addition to this, these health works are not well trained
and experienced in this specific disease. Due to this, most of
the patients prefer to come to Gondar where senior health
works are available which costs the patient more money. The
researcher also interviewed patients in the Research and
Treatment Center of Visceral Leishmaniasis that founds in
the University of Gondar Hospital by asking why they prefer
to come to Gondar and they replied that the health care
service in places where VL is endemic is not good enough to
cure them.
In order to help health workers to upgrade their knowledge
and experience and give high level medical health care
services and treatment, developing a Knowledge Base
System that gives advice about how to identify the VL
disease among the common tropical disease and how to treat
it, therefore, they would play a critical role to save many
lives.
Developing a knowledge based system would reduce the
repetition of task, the burden of human expert and waiting
time of patient in the hospital. The knowledge based system
could be used to assist human expert by providing the
required knowledge at the right time for decision making.
According to Global health,2014 report [20] ,identify
technology gap is one of the priority research area to
eliminate Visceral Leishmaniasis. Therefore, this study is
technological approach to solve the problem of VL diagnosis
confusion and mange treatment track.
In medical problems, using fuzzy logic system is more
recommended, because it can able to solve problems like
which are more subjective. The symptoms of the patients are
difficult to identify by using other reasoning mechanisms
like rule based and case based. The problem is that those
reasoning mechanisms depend on the specific rules given or
on the specific cases developed. Conditions in between the
two ranges cannot be identified by rule based and case based
rather it is easy in fuzzy logic. Fuzzy logic is able to consider
values in between and linguistic expressions [16].
Transformation of KBS into a mobile-based solution would
extend their benefits, facilitate and integration into medical
86
environments. It can also play a major role by providing
support in common clinical problems like prediction of
diseases, prevention of diseases, diagnosis of diseases,
provision of patients with medical information [21].
Nowadays, mobile phones are the most popular and widely
used means of communication for their compact size,
versatility, wireless communication, increasing capabilities
and ease of handling [21].
Hence, the proposed mobile based expert system will be
supported tools to health care worker for diagnosis VL. The
system primarily contains knowledge and experience of
specialized doctors’ full knowledge and make it real
advancing system for those health workers which serves as
means of easy ways of knowledge transfer. Therefore, the
community of Ethiopia get timely diagnosis and treatment,
this is a good opportunity to enhance the quality of health
care who lives rural areas and achieving the goal of
Millennium Goal.
This paper is organized as section 2 describes the literature
review and related work for our research field. Section 3
summarizes the importance of our research and conclude the
related work.
2. LITERATURE REVIEW
2.1 Nature And Feature Of Visceral Leishmaniasis
Leishmaniasis is one of the world’s most neglected diseases
and affects the poorest of the poor. It is reported from around
89 countries. Over 90% of cases of visceral Leishmaniasis
(VL or kala azar, KA) are found in India, Bangladesh,
Sudan, South Sudan, Brazil and Ethiopia; 350 million people
are considered at risk of contracting Leishmaniasis, and some
2 million new cases occur yearly [22].
The Leishmaniasis are generally subdivided in Old World
and New World Leishmaniasis, where the Old World
represents all countries except the America’s; Old World
Leishmaniasis is caused by parasites of the subgenus
Leishmania whereas in the America’s it is mostly caused by
parasites of a different subgenus (Viannia). Different parasite
species are implicated in Old and New World Leishmaniasis
[23].
Sandflies feed on animals or man. While taking blood meals,
the female sand flies may ingest Leishmania amastigotes
from the skin or blood of infected animals or man. Within
the sandfly the parasite develops in approximately one week
into an infective promastigote (flagellate form). Female
sandflies, needing protein for their eggs, also take a nocturnal
blood meal and this is when Leishmania infections are
acquired and transmitted [24].
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
The VL foci from which clinical cases are reported differ in
their eco-epidemiology and the sandfly vectors involved.
Currently, VL transmission is known to occur in three
different ecological settings, spanning from lower Kola to the
Woina Dega ecological zones (Figure 1)[25].
Figure 1:-Endemic foci of visceral Leishmaniasis. [25]
2.2 Risk Factor For VL Infection In Ethiopia
Studies shown that most of east African VL is more closely
related to the movement of seasonal workers and new
settlements to endemic or highly risk transmission zones [1].
This is hampered by poor working conditions and
infrastructures provided for labourers [11]. It generally result
humans into contact with natural vectors and increased
infection rates. East African VL caused by L. donovani is
being considered as anthroponotic [26].
Studies in VL the soil (black cotton soil), vegetation type
(Acacia-Balanite vegetation), presence of termite hills and
migration to endemic foci for seasonal agricultural work,
different behavioural, household and environmental factors
have been implicated as risk factors for VL in Ethiopia. All
these factors increase the contact between man and sand flies
[27] [28] [29].
There is not clear cut studies in Ethiopia about the
information on a different transmission route of VL.
According to Yared et al., 2014 study that conducted in
Northwest Ethiopia, Humera endemic focus similar scenario
documented that goat ownership and sleeping near dogs was
among the odds for clinical VL [30]. In neighbouring
country Sudan where VL due to L. donovani is one of a
public health problem, dogs and rodents are considered as
risk factors for disease transmission [31] [32] [33].
2.3 Diagnosis and Treatment of VL
Most medical diagnosis are includes clinical and laboratory
diagnosis. VL clinical diagnosis has been demonstrated to be
highly unspecific, imprecision and uncertain. According to
FMoH, 2013 VL clinical diagnosis based on case definition
“a person who presents with fever for more than two weeks
87
and an enlarged lymph nodes (lymphadenopathy), or either
loss of weight, anemia or leucopena while living in a known
VL edemic area or having travelled to an endemic area”.
Therefore, clinical suspicion of KA /VL must always be
followed by a demonstration of the presence of the parasite
either directly (microscopy) or indirectly (serology) [10].
Laboratory test will be able to make distinction between
acute or asymptomatic infections. Test include different
kinds such as non-Leishmanial tests, parasite detection,
antibody detection, antigen detection and molecular
techniques [34].
VL treatment have different kinds based on the patient
severity. They are First-Line Treatment Regimens for
Primary VL, Second-Line Treatment for Primary Visceral
Leishmaniasis and Treatment of VL Relapse. The First-Line
treatment is applied by combines Sodium Stibogluconate
(SSG) & Paromomycin therapy or Sodium Stibogluconate
(SSG) or Meglumin Antimoniate (Monotherapy) or
Liposomal Amphatericin B (LAmB,AmBisome). The
second-line VL treatment are strong idecations like drug
toxicity, relapse, treatment failure and very severe illness but
treatment should be stop when see sever vomiting.
Liposomal Amphotericin B (AmBisome), Miltefosine and
Paromomycin (Aminosidine) are drugs treatment in second
line treatment. Final treatment is VL Relapse treatment. It is
treatment which applied when a patient does not cure from
parasite at time of check-up, after having been successfully
treated from first and second line treatment [10] [1] [35].
2.4 Fuzzy Logic
Fuzzy logic theory was formalized by Professor Lofti Zadeh
at the University of California in 1965 [36].Theory of sets is
one of the important tools in modern mathematics. A set is a
collection of similar type of distinct objects known as the
element of the set. It deals with “degrees of truth” rather than
absolute values of “0 and 1” or “true/false”. Fuzzy logic is
not like a computer software which understands only binary
functions or real values like 2.5, 2.8, etc; instead, it is like to
human intelligent and clarification and gives meaning to
expressions like “often”, “smaller” and “higher”.
Fuzzy logic takes into account that real world is complex and
there are uncertainties; everything cannot have absolute
values and follow a linear function [37]. On one hand, logic
is more than bi-valued logic. In fact, many-valued logic is
part of logic and allows infinite truth values. On the other
one fuzziness measures the range of values of truth-ness that
we can assign to some sentence and this range can be given a
credibility so there is always a set of values that we can trust.
Together we talk about fuzzy logic, logic that can be used to
reason about fuzzy information and provide results with a
credibility.
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
According to Zadeh in 1992 [38], fuzzy logic has the performance for many applications, which require high level
following principles:- of uncertainties [41].

 Exact reasoning is viewed as a limiting case of
approximate reasoning.
 Everything is a matter of degree.
 Knowledge is interpreted as a collection of elastic,
fuzzy constraints on a collection of variables.
 Inference is viewed as a process of propagation of
elastic constraints.
 Any logical system can be “fuzzified”.
Type-1 FLSs cannot fully handle the high level of
uncertainties available in the vast majority of real world
applications. This is because type-1 FLSs employ crisp and
precise type-1 fuzzy sets. A type-2 FLS can handle higher
uncertainty levels to produce improved performance [41]
[42].
2.4.2. Type-2 Fuzzy Logic

In medical environment /diagnosis precise and certain are
driving force to come up an actual decision. Fuzzy logic
technology provides a simple way to arrive at a definite
conclusion from vague, imprecise and ambiguous medical
data. Visceral Leishmaniasis clinical diagnosis symptoms are
very related to many types diseases such as malaria,
hyperactive tropical splenomegaly, Typhoid fever, Typhus,
Brucellosis, Schistosomiasis, Military tuberculosis,
HIV/AIDS, Leukaemia.
The cases that are defined in VL clinical diagnosis case
definition are not consider value /degree between the ranges
rather it considers yes and no. Therefore, the diagnosis is so
difficult to make medical decision but Fuzzy logic is able to
consider values in between and linguistic expressions.
Type-2 fuzzy sets, introduced again by Zadeh in the year
1975, are used for modelling levels of uncertainty and
imprecision in a better way which traditional fuzzy
logic(type-1) struggles [43]. Later in the year 2001, Mandel
introduced a new concept which type-2 fuzzy set can be
characterized with an upper membership function and a
lower membership function [44]. The interval between these
two functions represents the footprint of uncertainty (FOU).
It is used to verbalize the shape of type-2 fuzzy sets it
implies that there is a distribution that sits on top of that
shaded area as sown on figure 2. The FOU provide additional
degree of freedom that can make it possible to directly model
and handle the uncertainties. Hence, type-2 fuzzy sets have
the potential to handle high uncertainty levels than their type-
1 fuzzy sets [45].

Fuzzy logic allows handling much of uncertainty. The

amount of uncertainty in a system can be reduced by using
type-2 fuzzy logic because this logic offers better capabilities
to handle linguistic uncertainties by modelling vagueness and
unreliability of information [39] .

2.4.1. Type-1 Fuzzy Logic

Type-1 fuzzy set introduced by Zadeh in 1965 [40]. It is

successful method of modelling uncertainty, vagueness and Figure 2: The interval type-2 FLC [41]
imprecision more than forty years. The use of type-1 fuzzy
sets in real computer systems is extensive, particularly in
consumer products and control applications.

Type-1 fuzzy logic using crisp input and precise fuzzy set for
model the user behaviour under specific conditions. Type-1
fuzzy sets can handle uncertainty by utilizes precise
membership functions which is uncertainties for user as them
believes. As soon as the type-1 membership functions had
been selected, all the uncertainties disappears, due to the
type-1, membership functions are totally precise. Even if, It
Figure 3: Interval type-2 fuzzy set [45]
has been applied more than forty years and success full many
different applications. It has limitation to cope with large
2.5 Overview Fuzzy Expert System
amounts of uncertainties of the real world. Real world
applications are characterized by high levels of linguistic and
numerical uncertainties. Hence, the traditional type-1 using The Expert system is derived from the field of artificial
type-1 sets cannot directly handle such uncertainties to intelligence as well as one of the main family members.
produce a new generation of fuzzy controllers with improved Artificial intelligence intends to understand human

88
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
intelligence behaviour like cognitive skill thinking, problem
solving, learning, understanding, emotion, consciousness,
intuition and creativity and building of computer programs
that are capable of simulation or acting one or more of those
behaviours [46].
Expert systems are designed to solve complex problems at
the level of a human expert by using specialized knowledge
represented a set of rules. A fuzzy expert system (FES) is an
expert system which include set of fuzzy rules and
membership functions [47].
A fuzzy expert system is an expert system, which consists of
fuzzification, fuzzy logic inference, knowledge base
(combination of fuzzy rules and database), and
defuzzification subsystems [48].
Figure 4: Architecture of fuzzy expert system [48]
2.6 Related work
Several numbers of researches have been conducted on
design fuzzy expert model for the diagnosis and treatment of
diseases. Some of them that are related to the proposed
problem discussed here below:
In [49] this study attempts to do a case comparison of the
fuzzy and Analytic Hierarch process (AHP) methods in the
development of medical diagnosis system, which involves
basic symptoms elicitation and analysis. The fuzzy logic is
able to handle vagueness and unstructured in decision
making, while the AHP has the ability to carry out pairwise
comparison of decision elements in order to determine their
importance in the decision process [50]. AHP is good in
processing multidimensional and hierarchically structured
data which calls for the relative importance of criteria
groupings. This feature is not found in fuzzy logic
methodology, which handles vague and imprecision of data
and moreover it resembles human decision making with its
ability to work from approximate reasoning and ultimately
find a precise solution. The study conducted for malaria
diagnosis. Final the study concluded that the fuzzy logic
shows a better but non-statistically significant performance
over the AHP methodology, and is better utilized in the
building of the entrant module in a hybrid system involving
both methodologies.
89
Many intelligent systems have been developed by applying
the hybrid algorithm. In [51] this research proposes a Hybrid
Intelligent System driven by Neural Network and Fuzzy
Logic to provide a decision support platform that will assist
medical practitioners in the efficient diagnosis of Typhoid
Fever. Fuzzy logic (FL) handles imprecise and incomplete
medical data where as a Neural Network (NN) component
which automatically generates the parameters that drive the
Membership Functions of Typhoid Fever diagnosis variables
for the Fuzzy Inference System. Hybridization of NN and FL
provides a solution that is capable of integrating the strength
of both techniques and eliminating their weaknesses. The
hybrid technique provides a method that allows the NN
modelling procedure to learn certain information about a
given dataset in order to automatically compute the MF
parameters that best drives the associated FIS [52]. However,
each of them has advantages and disadvantages. It is
therefore appropriate to hybridize these two techniques so as
to overcome the weakness of one with the strength of the
other. There has been an increasing need to combine NN and
FL for a successful development of an ES that would have a
human like reasoning capability [53]. NNs derive their
strengths from the ability to generalize data relationship and
their ability to handle data with non-linear relationship as
those found in medical records while FL help in handling
uncertainty found in medical data.
Importantly, medical diagnosis system classification have
been widely utilized for explore patient’s data and predictive
model. Mostafa F. and Mohammed S. developed a new
hybrid fuzzy classification algorithm, which was obtained by
utilized Ant colony optimization classification algorithm and
fuzzy logic for diabetes disease diagnosis, called FCS-
ANTIMINER. This model more efficient for diabetes disease
classification related problems, they obtained 84.24 %
accuracy. Being medical decision, it is generally acceptable
to maximizing the accuracy. Hence, One of the challenge of
this study score low accuracy [54].
From few fuzzy diagnosis systems on tropical disease [51]
study conducted diagnosis of Typhoid Fever (TF). This study
applied a hybrid Intelligent System engineered by Neural
Network and Fuzzy Logic techniques for the diagnosis of
TF. Fuzzy logic handles imprecise and incomplete medical
data, a Neural Network (NN) component which
automatically generates the parameters that drive the
Membership Functions of TF diagnosis variables for the
Fuzzy Inference System. The limitation of Neural Network
has lack of specific methods to determine the optimal
number and connection weights for hidden layers and their
respective nodes necessary for a particular problem. Hence,
optimization techniques recommended for improve the
performance of the proposed system.
[47] presents a Particle Swarm Optimization (PSO) with
fuzzy logic system for the diagnosis of Coronary Artery
Disease (CAD). PSO was applied to tune the fuzzy
membership functions for enhance the performance. They
Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
used Decision Tree (DT) to select important attribute from health workers which serves as means of easy ways of
large datasets and also used for convert crisp rules into fuzzy knowledge transfer. Therefore, the community of Ethiopia
values. However, the study selected 13 attribute from 76 get timely diagnosis and treatment, this is a good opportunity
attributes via many published experiment literatures, it will to enhance the quality of health care who lives rural areas
be recorded better performance to applying machine learning and achieving the goal of Millennium Goal.
techniques on filtering important attributes from large
dataset. We researchers proposed new mobile based VL disease
diagnosis with noble hybrid fuzzy approach which is
A work on fuzzy expert system for the management of mention on below figure 4.
malaria (FESM) was executed in [48]. The concerned system
was described as capable of providing decision support 4. CONCLUSION
platform to malaria researchers, medical doctors and other
healthcare practitioners in malaria endemic regions. This The main objective of this article is written to discuss the
developed system was composed of knowledge based, the power hybridize fuzzy logic with other soft computing
fuzzifier, the inference engine and defuzzifier. The algorithm in medical diagnosis. The paper also proposed a
developed used a triangular typed membership function for
the fuzzification of scalar inputs, a fuzzy inference method of
root sum square (RSS) and finally, the defuzzifier employed
the popular and effective center of gravity method of
defuzzification. In this study 35 selected patients of malaria Training data
were diagnosed. Knowledge
Acquisition
In [45], an interval Type-2 fuzzy were used to recognized
patterns of Fatal Heart Rate (FHR) for predicting fatal well-
being in medical antenatal care system. The output of the
study is a system that used for classifying diagnosis of fatal
health. As per researcher knowledge, few kinds of researches Web Server
are conducted on the combination of soft computing
techniques (hybrid) that play vital role in the improvement of Apply Machine Learning Test data
the system performance of IT2FLS. For example, Najafi et
algorithm from
al. [55] used fuzzy C-means (FCM) clustering algorithm to
R
improve the performance of IT2FLS in the classification of e (Neural network + ant colony Health
Celiac Disease (CD). Rahil et al. [56] was employed genetic v
i optimization) care
algorithm for tuning of the Membership Function (MF) s
parameters and footprint of uncertainty in order to improve e

the performance of IT2FLS classifier which is a lung

computer aided detection (CAD) system for classification of
nodules Generate set fuzzy rules

3. DISCUSSION

As we have discussed on related work, fuzzy logic and soft

computing are playing great role on medical decision like VL Apply type-2 fuzzy logic
that have uncertainty physical medical diagnosis system
manifestation and high fatal disease. Therefore, due to high
uncertainty in the medical data, Type-2 fuzzy (IT2FLS) is
able to consider much linguistic uncertainty and considering
the uncertainty in the membership functions. In addition, it is
a new and current method in medical diagnosis.
Make
medical
Hence, the proposed mobile based expert system will use
Novel Hybrid Type-II Fuzzy logic (NHIT2FLS) approach. A
c
The approach combinations of Type-II, Neural Network and c
e
Ant Colony techniques. The system will be supported tools p
NO t

to health care worker for diagnosis VL. The system primarily Yes
contains knowledge and experience of specialized doctors’ Does it
full knowledge and make it real advancing system for those correct?
90

Figure 4: The proposed design

Yosef Berhanu Buladie et al., International Journal of Advances in Computer Science and Technology, 7(12), December 2018, 83- 93
novel approach on hybrid fuzzy logic expert system on
disease diagnosis of Visceral Leishmaniasis.
Ethiopia is one the ten high burden countries for VL,
estimated 2,000-4,500 annual cases. Above 60% VL
endemic areas are remote or rural areas as well as the VL is
disease transmitted human to human via female sanyfile. Still
now there is not mechanize to protect /handle the vector
reproduction [19].
Ethiopia, almost Africa has very limited senior human
doctors. Even though they are short in number, many
educated man powers particularly senior doctors and nurses
are not willing to go to places where VL is endemic due to
the above problems, persons who are infected with VL are
left untreated. In addition to this, patients could not go to
places where VL diagnosis and treatment is available
because it costs them huge amount of money.
Due to this, Health education or promotion is a core element
of any disease prevention and control program. The target
group for health education might include public health
managers, health staff, community health workers and
leaders, people living in endemic areas and patients. In
Ethiopia, the introduction of the health extension program is
quite helpful for disease control programs with strong
activities on the community level [10].
However, these health workers who are included in the
health extension program are not capable enough to give
appropriate medical health care services and treatment for
patients because the knowledge of these persons about how
to diagnosis a person with VL and give treatment is not
adequate enough to give high level medical health care
services and treatment. Due to this, most of the patients
prefer to come to Gondar where senior health works are
available.
Therefore, in order to combat this problem developing and
implementing an expert System that provides advice to
health workers would play a great role because expert system
provides the high-quality performance which solves difficult
problems in a domain as good as or better than human
experts and can possesses vast quantities of domain specific
knowledge to the minute details [57] [58] which can in turn
serve as means of knowledge and experience transfer
because the ability of the intelligent systems to capture and
redistribute expertise has significant implications on
development of a nation, commodity or population. In
addition to this, such systems allow documentation of one or
more expert knowledge and utilize the knowledge for
problem solving in cost effective way. It allows for, in a
controlled manner, the import of expertise in various areas
that the nation lacks, the export of knowledge relating to
domestic areas of expertise, and the duplication and
redistribution of scarce knowledge in a cost effective
manner. Thus areas of expertise that the selected
91
domain/region/nation is deficient in or possesses exclusively
are potential candidates of the knowledge-based systems
[58].
Nowadays the technology shift into mobile because the
mobile device is no longer an island device but is rather fully
connected to other personal devices [such as a personal
computer (PC), tablet, or television (TV)] and
data/information, enabling seamless and continuous
transition between devices, where each device simply
provides a different modality and view into a central
repository of data/information in the cloud.
Generally, most of the mobile devices are more appropriate
tools and have become an inseparable part of our life, so as
the need for mobile-based healthcare service becomes
substantial as it integrates healthcare more seamlessly to our
everyday life. Finally, this paper expected to address its long
run aims provided mobile based expert system to health
worker.
ACKNOWLEDGMENT
Let me give thanks to the owner of this supernatural power and
creature of the entire universe, almighty GOD for helping me to
finalize this work. My immense gratitude is to my advisor Dr. Lars
Rune Christensen for his critical comments, encouragement and
guidance on throughout the completion of this work.
You showed everything to me how to tackle problems by investing
your invaluable time. I really thank you! Throughout the
completion of this thesis, you have been consistently sharing me
constructive ideas and comments about this work in a friendship
mode, which I appreciate most and take you as a role model in my
life.
I am also grateful to my sponsor institution University of Gondar,
Ethiopia to giving educational opportunities at Sudan. It is my
pleasure to express my gratitude to Sudan University of Science and
Technology for doing my PhD.
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